Elderly Medication Adherence Intervention Using the My Interventional Drug-Eluting Stent Educational App: Multisite Randomized Feasibility Trial

Andrew Dallas Boyd, Chioma Iheanyi Ndukwe, Anandu Dileep, Olivia Frances Everin, Yingwei Yao, Betty Welland, Jerry Field, Matt Baumann, Jose D Flores Jr, Adhir Shroff, Vicki Groo, Carolyn Dickens, Rami Doukky, Regeena Francis, Geraldine Peacock, Diana J Wilkie, Andrew Dallas Boyd, Chioma Iheanyi Ndukwe, Anandu Dileep, Olivia Frances Everin, Yingwei Yao, Betty Welland, Jerry Field, Matt Baumann, Jose D Flores Jr, Adhir Shroff, Vicki Groo, Carolyn Dickens, Rami Doukky, Regeena Francis, Geraldine Peacock, Diana J Wilkie

Abstract

Background: A lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy, a combination of P2Y12 inhibitors and aspirin.

Objective: This study aimed to determine the acceptability of a protocol and an intervention using the My Interventional Drug-Eluting Stent Educational App (MyIDEA) and to evaluate medication adherence using the proportion of days covered (PDC) and platelet activation tests in a multisite randomized controlled trial.

Methods: Potential participants who received a post percutaneous coronary intervention (PCI) procedure with a drug-eluting stent were approached. All patients older than 50 years and who spoke English were recruited. Participants were recruited, baseline demographics were collected, and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form, Burden-Benefit questionnaire, 36-Item Short Form Health Survey, and PCI knowledge questionnaire were administered. Block randomization was used to randomize participants to either usual care or MyIDEA supplementation. MyIDEA is a personalized educational intervention based on the Kolb experiential learning theory using patient narratives for education. During the visits, participants' blood was collected to measure platelet suppression from medication. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H Stroger Jr Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units and P2Y12 reactive units. Medication adherence was measured using the PDC. The analysis team was blinded to the participants' group membership. The primary outcome was a feasibility analysis of recruitment and retention.

Results: The mean age of participants was 60.4 years (SD 7.1); the majority of patients were black and non-Hispanic. The majority of patients' reading levels were seventh grade or above, and they were not very familiar with other electronic devices for information and communication. The number of control subjects was 21, and the number of participants in the interventional arm was 24. The interventional group was able to use MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in terms of depression and anxiety, initially, as measured by HADS. No documented adverse event associated with the intervention was found.

Conclusions: Elderly patients are willing to use tablet devices to be educated about health conditions. Additional studies are required to measure the effectiveness and determine the most suitable timing and location for patient education.

Trial registration: ClinicalTrials.gov NCT04439864; https://ichgcp.net/clinical-trials-registry/NCT04439864.

Keywords: Kolb learning theory; drug eluting stents; medication adherence; mobile application; patient education; percutaneous coronary intervention.

Conflict of interest statement

Conflicts of Interest: None declared.

©Andrew Dallas Boyd, Chioma Iheanyi Ndukwe, Anandu Dileep, Olivia Frances Everin, Yingwei Yao, Betty Welland, Jerry Field, Matt Baumann, Jose D Flores Jr, Adhir Shroff, Vicki Groo, Carolyn Dickens, Rami Doukky, Regeena Francis, Geraldine Peacock, Diana J Wilkie. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 24.06.2020.

Figures

Figure 1
Figure 1
Flow diagram of research participants.
Figure 2
Figure 2
The average percentage of time spent on slides.

References

    1. Smith Sr SC, Feldman TE, Hirshfeld JW, Jacobs AK, Kern MJ, King SB, Morrison DA, O'Neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B, American College of Cardiology/American Heart Association Task Force on Practice Guidelines. American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions Writting Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention) Circulation. 2006 Jan 3;113(1):156–75. doi: 10.1161/CIRCULATIONAHA.105.170815.
    1. Piccolo R, Windecker S. Dual antiplatelet therapy in percutaneous coronary intervention: a tale of 2 decades with new perspectives in the era of new-generation drug-eluting stents. Circ Cardiovasc Interv. 2016 Feb;9(2):e003587. doi: 10.1161/CIRCINTERVENTIONS.116.003587.
    1. Thim T, Johansen MB, Chisholm GE, Schmidt M, Kaltoft A, Sørensen HT, Thuesen L, Kristensen SD, Bøtker HE, Krusell LR, Lassen JF, Thayssen P, Jensen LO, Tilsted H, Maeng M. Clopidogrel discontinuation within the first year after coronary drug-eluting stent implantation: an observational study. BMC Cardiovasc Disord. 2014 Aug 13;14:100. doi: 10.1186/1471-2261-14-100.
    1. Spertus JA, Kettelkamp R, Vance C, Decker C, Jones PG, Rumsfeld JS, Messenger JC, Khanal S, Peterson ED, Bach RG, Krumholz HM, Cohen DJ. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation. 2006 Jun 20;113(24):2803–9. doi: 10.1161/CIRCULATIONAHA.106.618066.
    1. Pfisterer M, Rocca HP, Buser PT, Rickenbacher P, Hunziker P, Mueller C, Jeger R, Bader F, Osswald S, Kaiser C, BASKET-LATE Investigators Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents. J Am Coll Cardiol. 2006 Dec 19;48(12):2584–91. doi: 10.1016/j.jacc.2006.10.026.
    1. Lagerqvist B, James SK, Stenestrand U, Lindbäck J, Nilsson T, Wallentin L, SCAAR Study Group Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med. 2007 Mar 8;356(10):1009–19. doi: 10.1056/NEJMoa067722.
    1. Kastrati A, Mehilli J, Pache J, Kaiser C, Valgimigli M, Kelbaek H, Menichelli M, Sabaté M, Suttorp MJ, Baumgart D, Seyfarth M, Pfisterer ME, Schömig A. Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med. 2007 Mar 8;356(10):1030–9. doi: 10.1056/NEJMoa067484.
    1. Ferreira-González I, Marsal JR, Ribera A, Permanyer-Miralda G, Blanco BG, Martí G, Cascant P, Martín-Yuste V, Brugaletta S, Sabaté M, Alfonso F, Capote ML, de La Torre JM, Ruíz-Lera M, Sanmiguel D, Cárdenas M, Pujol B, Baz JA, Iñiguez A, Trillo R, González-Béjar O, Casanova J, Sánchez-Gila J, García-Dorado D. Background, incidence, and predictors of antiplatelet therapy discontinuation during the first year after drug-eluting stent implantation. Circulation. 2010 Sep 7;122(10):1017–25. doi: 10.1161/CIRCULATIONAHA.110.938290.
    1. Airoldi F, Colombo A, Morici N, Latib A, Cosgrave J, Buellesfeld L, Bonizzoni E, Carlino M, Gerckens U, Godino C, Melzi G, Michev I, Montorfano M, Sangiorgi GM, Qasim A, Chieffo A, Briguori C, Grube E. Incidence and predictors of drug-eluting stent thrombosis during and after discontinuation of thienopyridine treatment. Circulation. 2007 Aug 14;116(7):745–54. doi: 10.1161/CIRCULATIONAHA.106.686048.
    1. Ho PM, Tsai TT, Maddox TM, Powers JD, Carroll NM, Jackevicius C, Go AS, Margolis KL, DeFor TA, Rumsfeld JS, Magid DJ. Delays in filling clopidogrel prescription after hospital discharge and adverse outcomes after drug-eluting stent implantation: implications for transitions of care. Circ Cardiovasc Qual Outcomes. 2010 May;3(3):261–6. doi: 10.1161/CIRCOUTCOMES.109.902031.
    1. Garavalia L, Ho PM, Garavalia B, Foody JM, Kruse H, Spertus JA, Decker C. Clinician-patient discord: exploring differences in perspectives for discontinuing clopidogrel. Eur J Cardiovasc Nurs. 2011 Mar;10(1):50–5. doi: 10.1016/j.ejcnurse.2010.04.002.
    1. Garavalia L, Garavalia B, Spertus JA, Decker C. Exploring patients' reasons for discontinuance of heart medications. J Cardiovasc Nurs. 2009;24(5):371–9. doi: 10.1097/JCN.0b013e3181ae7b2a.
    1. Moussa ID, Colombo A. Antiplatelet therapy discontinuation following drug-eluting stent placement: dangers, reasons, and management recommendations. Catheter Cardiovasc Interv. 2009 Dec 1;74(7):1047–54. doi: 10.1002/ccd.22167.
    1. Bitton A, Choudhry NK, Matlin OS, Swanton K, Shrank WH. The impact of medication adherence on coronary artery disease costs and outcomes: a systematic review. Am J Med. 2013 Apr;126(4):357.e7–e27. doi: 10.1016/j.amjmed.2012.09.004.
    1. Shroff A, Ali A, Groo VL. Clopidogrel adherence following percutaneous coronary intervention with a drug-eluting stent in a VA Medical Center. J Pharm Technol. 2009;25(3):164–8. doi: 10.1177/875512250902500304.
    1. Kontos E, Blake KD, Chou WS, Prestin A. Predictors of eHealth usage: insights on the digital divide from the Health Information National Trends Survey 2012. J Med Internet Res. 2014 Jul 16;16(7):e172. doi: 10.2196/jmir.3117.
    1. Xu L, Li F, Zhou C, Li J, Hong C, Tong Q. The effect of mobile applications for improving adherence in cardiac rehabilitation: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2019 Jul 12;19(1):166. doi: 10.1186/s12872-019-1149-5.
    1. Ayyaswami V, Padmanabhan DL, Crihalmeanu T, Thelmo F, Prabhu AV, Magnani JW. Mobile health applications for atrial fibrillation: A readability and quality assessment. Int J Cardiol. 2019 Oct 15;293:288–93. doi: 10.1016/j.ijcard.2019.07.026.
    1. Hsu G, Crawford S, Paolella G, Cuellar S, Wirth S, Venepalli N, Wang E, Hughes D, Boyd A. Design of customized mobile application for patient adherence to oral anticancer medications utilizing user-centered design. J Biocommun. 2017;41(1) doi: 10.5210/jbc.v41i1.7499.
    1. Militello LG, Saleem JJ, Borders MR, Sushereba CE, Haverkamp D, Wolf SP, Doebbeling BN. Designing colorectal cancer screening decision support: a cognitive engineering enterprise. J Cogn Eng Decis Mak. 2016 Mar;10(1):74–90. doi: 10.1177/1555343416630875.
    1. Boyd AD, Moores K, Shah V, Sadhu E, Shroff A, Groo V, Dickens C, Field J, Baumann M, Welland B, Gutowski G, Flores JD, Zhao Z, Bahroos N, Hynes DM, Wilkie DJ. My interventional drug-eluting stent educational app (MyIDEA): patient-centered design methodology. JMIR Mhealth Uhealth. 2015 Jul 2;3(3):e74. doi: 10.2196/mhealth.4021.
    1. Kolb DA. Experiential Learning: Experience as the Source of Learning and Development. New Jersy: Prentice Hall; 1984.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002 Feb;52(2):69–77. doi: 10.1016/s0022-3999(01)00296-3.
    1. Davis TC, Long SW, Jackson RH, Mayeaux EJ, George RB, Murphy PW, Crouch MA. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993 Jun;25(6):391–5.
    1. Pessin H, Galietta M, Nelson CJ, Brescia R, Rosenfeld B, Breitbart W. Burden and benefit of psychosocial research at the end of life. J Palliat Med. 2008 May;11(4):627–32. doi: 10.1089/jpm.2007.9923.
    1. Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. Br Med J. 1992 Jul 18;305(6846):160–4. doi: 10.1136/bmj.305.6846.160.
    1. Shah V, Dileep A, Dickens C, Groo V, Welland B, Field J, Baumann M, Flores JD, Shroff A, Zhao Z, Yao Y, Wilkie DJ, Boyd AD. Patient-centered tablet application for improving medication adherence after a drug-eluting stent. Front Public Health. 2016;4:272. doi: 10.3389/fpubh.2016.00272. doi: 10.3389/fpubh.2016.00272.
    1. Instrumentation Laboratory Worldwide. 2013. [2020-02-11]. VerifyNOW PRUTest Platelet Reactivity Test Instructions for Use .
    1. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986 Jan;24(1):67–74. doi: 10.1097/00005650-198601000-00007.
    1. Buuren SV, Groothuis-Oudshoorn K. mice: Multivariate imputation by chained equations in R. J Stat Soft. 2011;45(3) doi: 10.18637/jss.v045.i03.
    1. Huber A, Oldridge N, Höfer S. International SF-36 reference values in patients with ischemic heart disease. Qual Life Res. 2016 Nov;25(11):2787–98. doi: 10.1007/s11136-016-1316-4.
    1. Park LG, Howie-Esquivel J, Dracup K. Electronic measurement of medication adherence. West J Nurs Res. 2015 Jan;37(1):28–49. doi: 10.1177/0193945914524492.
    1. de Oliveira R, Cherubini M, Oliver N. MoviPill: Improving Medication Compliance for Elders Using a Mobile Persuasive Social Game. Proceedings of the 12th ACM international conference on Ubiquitous computing; UbiComp'10; September 26 - 29, 2010; Denmark. Proceedings of the 12th ACM international conference on Ubiquitous computing: ACM; 2010. pp. 251–60.

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